Background: Tanzania Health Promotion Support started supporting PMTCT services in Zanzibar through PEPFAR in October 2016. Prior to this, the program was managed by Zanzibar Integrated HIV TB and Leprosy Program (ZIHTLP) since PEPFAR support commencement in Tanzania in 2004.
Among the challenges noted by THPS were lower ANC coverage (81%) compared to Kigoma (97%) and Pwani (95%); low male partner involvement at 5%, compared to Kigoma 87% and Pwani 79%, and high numbers of women coming to Labor and Delivery with unknown HIV status where THPS serves as the IP since 2013. These challenges were seen as barriers towards eliminating MTCT as we are heading to 2020.
Strategies: To improve the situation; THPS strategized internally on how to address the barriers and in collaboration with ZIHTLP implemented the following:
• Sensitization of Facility in charges and HCPs at RCH and other units: This was done on the importance of comprehensive ANC HIV testing, male involvement in PMTCT services, improved documentation and how to make their clinics friendly for those who come with their partners. It was agreed that couples would be prioritized; and the male partner will be offered other services like weight and Blood Pressure and sugar measurements.
• Sensitization of Religious and Community leaders: Realizing that Zanzibar community is dominantly Muslim (99%); THPS facilitated a meeting of religious leaders inviting the Mufti for Zanzibar and his top management team to advocate for uptake of PMTCT and male involvement in PMTCT services. This was followed by countrywide sensitization, meetings in all districts of Unguja and Pemba, each meeting with an average of 50 participants including local government, politicians (District Commissioner, District Sheikh, Sheikhs of all mosques in the district, all She has i.e. Ward leaders)and other influential people in the area. The meetings were organized and facilitated by Office of Mufti so the main speaker was Mufti and his team. THPS/ZIHTLP role was to address technical aspects of PMTCT.
• Incentives to Couples: The team established ‘Mama Pack Kit’ (Khanga, sanitary pads, surgical gloves) to motivate pregnant women who come with their partners to ANC services.
• Equipping Health Facilities: HFs were equipped with BP machines, Glucometers and their kits to facilitate weight, Blood Pressure and sugar measurement for male partners.
• Invitation letters: These were given to all pregnant women attending ANC services without their partners aiming to invite them.
• Supportive supervision and Mentorship: THPS and ZIHTLP conduced ongoing supportive supervision checking on the availability of ARVs and supplies including HIV test kits, ME tools and assessing quality of documentation.
Results: The implementation of the strategies resulted into increased ANC attendance, reduced rates of unknown L&D and improved male involvement, from 5% in October – December 2016 to 62% in July- September 2017 as shown in the figures below.
Mufti led PMTCT sensetization meeting in Zanzibar with Shehes, Shehas, ZIHTLP and THPS